senate Bill S1083

Relates to the reimbursement of out-of-network providers of clinical laboratory services

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 09 / Jan / 2013
    • REFERRED TO HEALTH
  • 08 / Jan / 2014
    • REFERRED TO HEALTH

Summary

Relates to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans.

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Bill Details

See Assembly Version of this Bill:
A636
Versions:
S1083
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd §4406, Pub Health L; amd §4804, Ins L
Versions Introduced in Previous Legislative Cycles:
2011-2012: S2817, A3802
2009-2010: A11385, A11385

Sponsor Memo

BILL NUMBER:S1083

TITLE OF BILL:
An act
to amend the public health law and the insurance law, in relation to the
reimbursement of out-of-network providers of clinical laboratory
services by organizations providing or offering comprehensive health
services plans

PURPOSE:
The purpose of this legislation is to provide that organizations
providing or offering comprehensive health services plans, such as
managed care organizations and health maintenance organizations,
directly reimburse out-of-network providers of clinical laboratory
services when plan participants are referred to out-of-network
providers by in-network organizations or providers.

SUMMARY OF PROVISIONS:
Section 1. Section 4406 of the public health law by adding a new
subdivision 6. The new subdivision provides when the participant or
enrollee is referred to non-participating medical providers by
in-network medical providers, the services must be reimbursable under
the plan; requiring the out-of-network to bill the in-network
organization directly for services performed. Any payment made by the
medical provider directly to the participant rather than to the
out-of-network provider will not satisfy the organization's payment
obligation to the clinical laboratory.

Section 4804 of the insurance law is amended by adding a new
subsection (g) to with provisions that are identical to the foregoing.

JUSTIFICATION:
In an effort to provide the best health care available, health care
organizations and providers outside of such patients' organization's
networks. Under current law, however, such organizations are not
required to directly reimburse out-of-network providers for clinical
laboratory services rendered. Instead, out-of-network providers of
clinical laboratory services must look directly to the patients for
payment of their fees, even though patients are less likely to pay
for the services once rendered and may assume that the organization
is required to pay for the services. This provides a disincentive to
out-of-network providers to render services to such patients even in
cases where the out of network provider may offer better services.
This practice also thwarts the medical advice and direction of the
patient's medical care giver and limits patient healthcare options.

This legislation would expand the health care service options
available to the residents of the state and promote the referral of
patients to providers deemed to be the best for the medical care of
such patients, whether in or out-of-network.

LEGISLATIVE HISTORY:

S2817/A3802 of 2011-12; Committed to Rules

FISCAL IMPLICATIONS:


None.

EFFECTIVE DATE:
This act shall take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1083

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sen. MAZIARZ -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law and the insurance law, in relation
  to the reimbursement of out-of-network providers of clinical laborato-
  ry services  by  organizations  providing  or  offering  comprehensive
  health services plans

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 4406 of the public health law is amended by  adding
a new subdivision 6 to read as follows:
  6.  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF  LAW, IF AN ENROLLEE IS
REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES  NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER")
FOR ANY SERVICE COVERED UNDER THE TERMS OF THE  PLAN,  THE  ORGANIZATION
SHALL  BE  RESPONSIBLE  FOR  PAYMENT  DIRECTLY  TO THE NON-PARTICIPATING
PROVIDER FOR THOSE SERVICES IN ACCORDANCE WITH THE TIME FRAME  FOR  SUCH
PAYMENTS  SET  FORTH IN SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A
OF THE INSURANCE LAW; PROVIDED, HOWEVER,  THAT  THE  ENROLLEE  SHALL  BE
RESPONSIBLE FOR ANY APPLICABLE COPAY, COINSURANCE OR DEDUCTIBLE FOR SUCH
SERVICES.  CLINICAL  LABORATORIES SEEKING REIMBURSEMENT PURSUANT TO THIS
SECTION FOR SERVICES RENDERED SHALL DIRECTLY BILL THE ORGANIZATION WHOSE
ENROLLEE RECEIVED THE SERVICES. ANY  PAYMENT  MADE  BY  AN  ORGANIZATION
DIRECTLY  TO THE ENROLLEE RATHER THAN TO THE CLINICAL LABORATORY SEEKING
REIMBURSEMENT SHALL NOT SATISFY THE ORGANIZATION'S PAYMENT OBLIGATION TO
THE CLINICAL LABORATORY.
  S 2. Section 4804 of the insurance law is  amended  by  adding  a  new
subsection (g) to read as follows:
  (G)  NOTWITHSTANDING  ANY  OTHER  PROVISION  OF LAW, IF AN ENROLLEE IS
REFERRED BY AN IN-PLAN PROVIDER TO A  PROVIDER  OF  CLINICAL  LABORATORY
SERVICES  NOT PARTICIPATING IN THE PLAN (A "NON-PARTICIPATING PROVIDER")

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02255-01-3

S. 1083                             2

FOR ANY SERVICE COVERED UNDER THE TERMS OF THE  PLAN,  THE  ORGANIZATION
SHALL  BE  RESPONSIBLE  FOR  PAYMENT  DIRECTLY  TO THE NON-PARTICIPATING
PROVIDER FOR THOSE SERVICES IN ACCORDANCE WITH THE TIME FRAME  FOR  SUCH
PAYMENTS  SET  FORTH IN SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A
OF THIS CHAPTER; PROVIDED, HOWEVER, THAT THE ENROLLEE SHALL BE RESPONSI-
BLE FOR  ANY  APPLICABLE  COPAY,  COINSURANCE  OR  DEDUCTIBLE  FOR  SUCH
SERVICES.  CLINICAL  LABORATORIES SEEKING REIMBURSEMENT PURSUANT TO THIS
SECTION FOR SERVICES RENDERED SHALL DIRECTLY BILL THE ORGANIZATION WHOSE
ENROLLEE RECEIVED THE SERVICES. ANY  PAYMENT  MADE  BY  AN  ORGANIZATION
DIRECTLY  TO THE ENROLLEE RATHER THAN TO THE CLINICAL LABORATORY SEEKING
REIMBURSEMENT SHALL NOT SATISFY THE ORGANIZATION'S PAYMENT OBLIGATION TO
THE CLINICAL LABORATORY.
  S 3. This act shall take effect immediately.

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